Health Care Fact Check: Will abortion be covered?

View full sizeAlex Brandon, Associated PressOhio Democratic Rep. Marcy Kaptur leaves the West Wing of the White House in Washington last week after President Barack Obama signed an executive order that reaffirms the Patient Protection and Affordable Care Act's consistency with longstanding restrictions on the use of federal funds for abortion. Health CareFact Check

Does the health care reform bill change anything as far as abortion goes?

That depends.

It's a complicated issue that starts with this fact: The new law forbids federal tax dollars from going toward abortions except in cases of rape, incest or when a doctor documents that the woman's life is at risk.

That's been the law since 1977. So, if you're a federal employee or you're serving in the military, nothing will change. Abortion will only be covered in the above circumstances.

Ohioans who have employer-provided or other private insurance probably won't see changes either, according to some experts. As of now, the majority of those plans cover abortions and should continue to do so, says Alina Salganicoff, vice president and director of women's health policy at the nonprofit Kaiser Family Foundation.

Not everyone agrees with Salganicoff on that, but we'll get to that in a minute. And know this, five states -- Idaho, Kentucky, Missouri, North Dakota and Oklahoma -- prohibit private insurance coverage for abortions unless the woman meets one of the three federal criteria listed above.

So who's most likely to see changes? Americans who are uninsured now.

And they fall into two general categories.

• Uninsured individualswho earn up to 133 percent of the federal poverty level ($29,327 for a family of four). Under health-care reform, they'll be covered by an expanded Medicaid program, beginning in 2014. Because Medicaid is paid for with state money in addition to federal taxes, states have crafted their own abortion policies for those who are covered by it.

Ohio allows Medicaid abortion coverage only in cases of rape, incest or the threat to the life of the woman. So, unless Ohio changes its policy Medicaid recipients here will have abortions covered only in those cases.

• Uninsured individualswho earn between 133 and 400 percent of the federal poverty level ($29,327 to $88,200 for a family of four). Under the reform bill, they must enroll in the new health-care exchanges or pay a penalty. An exchange is a collection of insurance plans that, among other things, allow people -- many using federal subsidies -- and businesses to buy insurance at group rates instead of paying higher individual rates.

Each state can decide whether its exchanges will cover abortion. We have to wait to see what Ohio decides. But states that say "yes" to abortion coverage must also require exchanges to offer polices that don't cover it. And plans that do offer abortion coverage must charge an additional fee of at least $1 a month for it.

Here's where it gets tricky: As noted, many of those who enroll in the exchanges will receive federal subsidies to help pay the cost of the insurance. But the new law says they can't use that federal money to pay for abortion coverage. They can, however, pay for abortion coverage with their own money.

It may never come to that.

Some experts say that the exchanges won't want the headache and cost of dealing with different plans and keeping federal and nonfederal money in separate pots to ensure that no federal money ever pays for an abortion. Those experts predict that the exchanges will stop offering abortion coverage altogether.

That could become a big issue over time because the exchanges are expected to expand. Beginning in 2014, when the exchanges are launched, individuals and small businesses can join them. But starting in 2017, bigger businesses can start buying insurance through the exchanges, too. So, potentially, a large percentage of Americans could end up without abortion coverage, compared to the majority who have it now -- should the exchanges do away with abortion coverage.

Exactly what happens remains to be seen. Much of it will be up to what states and insurance companies decide. But it could also depend on how hard pro- and anti-abortion activists push their agendas in coming years.

Either way, many Americans will be affected.

Abortion is one of the most common surgical procedures performed on women, according to the Guttmacher Institute, which says more than 45 million legal abortions were performed in the United States between 1973 and 2005.